Crisis in LTCH – an interview with the CEO of Sienna Senior Living

di Priscilla Pajdo del April 24, 2020

TORONTO - The Covid-19 pandemic is far from over. The sense of crisis and urgency was heightened April 22 when Premier Ford called on the Military for human resources support in, of all places, Long Term Care Homes (LTCH). As of April 21, 43% of all fatalities attributed to the spread of Covid-19 occurred in LTCH.

Corriere interviewed Lois Cormack CEO, of Sienna Senior Living (Sienna), Canada’s largest owner/operator of LTCH and Retirement Residences. Sienna has 83 locations in Ontario and British Columbia: 35 LTCH and 27 Retirement Residences in Ontario.

Was Sienna taken unawares by the severity of the virus? Given its impact on the elderly especially, did you take any steps to prevent its spread?
“Back in November (2019) we started our annual influenza preparedness by vaccinating residents. We also enhanced our cleaning protocols and stockpiling supplies of personal protective equipment (PPE) such as, masks/gowns/gloves etc. We do this as a matter of course given the nature of our clientele and the obligations imposed by the Ministry. In December, we focused increasing attention on Covid-19 as the virus began to spread across China. We ramped up our protocols. As government started to issue directives in February/March, we implemented screening, testing programs and started restricting visitations to essential visitors to minimize exposure.”

Who was screened and tested? Residents? Staff ?
“Keep in mind we had already administered precautionary [flu] vaccinations with residents. So, we turned our attention to staff. Sienna employs 12,000 staff across all their 83 locations. In LTCH, we employ one Registered Nurse (RN) around the clock with a number of Registered Practical Nurse (RPN) on each shift depending on the home. The majority of staff are PSWs accounting for 50-60% of the work force in LTC homes.”

Despite these preparedness measures, Covid-19 has still managed to gain access into your LTCH and Retirement Centres.
“Regrettably, in 9 of our 83 centres. For us, that is an 11% rate we had hoped to avoid. But we are talking about people in relatively close quarters – acceptable and even desirable in normal times – when the virus infects…”.

What about testing?
“Public health conducts testing on residents exhibiting symptoms and it often takes 3-5 days for results. What complicates matters is that some individuals are asymptomatic, as far as staff is concerned that presents even greater challenges because 40% of the workforce is part/ time – they are in and out. It is possible that such asymptomatic staff or other individuals may have introduced the virus into the homes. It has been a logistical challenge… not withstanding, 74 homes are virus free… so far. This is likely how Covid-19 entered the homes, prior to when precautionary protocols and universal masking were put in place, back in early March. Public Health issued new directives on April 17 calling for increased testing in all case positive homes. This will now include individuals who are asymptomatic and are in contact with those who are exhibiting ongoing symptoms.”

As of April 21, Sienna confirmed 319 residents and 125 team members who tested positive for Covid-19 across 9 of their locations. How do you manage residents who test positive?
“Keep in mind we have about 12,000 staff and 12,000 residents. Space is an issue. We cannot practice social distancing. In Ontario, 60% of beds in LTCH are private or semi-private. Residents in these accommodations who undergo testing are put into isolation in their rooms while awaiting results. The balance of remaining rooms may have 4 beds to a room. This poses a greater risk factor for contagion. There may be 60-80 residents in homes under these conditions. Secondly, Government funding covers approximately one PSW per 10 residents. Once a resident is confirmed positive, in these circumstances, they are isolated in their rooms, and, that PSW must bring their meals/snacks and feed them and tend to them as usual. As even staff members begin to test positive, they are unable to work. Some of the other part time staff choose not to come to work under the current conditions. This poses a tremendous strain on the remaining staff looking after the residents.”

So, how are you managing these staffing issues? Have you planned to hire more staff? Premier Ford has introduced various measures, such as flexibility, to address staffing issues and committed funding to support costs associated in this fight.
“We have been trying to redeploy staff from other homes to help ease the strain in harder hit homes with outbreak. We cannot force people to go to work, especially now when they fear infection. Even with those measures, one PSW may still be caring for 20 residents instead of the usual 10. Moreover, once a LTCH has tested positive for Covid-19 staff are not permitted to work in other facilities. We are constrained by regulations and the natural fear of all staff."

So, the homes that are impacted the most are still waiting to feel some reprieve despite the new measures? What is your inventory of PPE?
“All homes have an adequate supply of PPE, including surgical masks. These masks are adequate to keep the virus from spreading. These supplies can also be moved between homes to help support those homes with outbreaks.”

Are you able to tap into hospitals for support in the event a confirmed case proves serious?
“They are overwhelmed with their usual clientele. To add ours has been difficult. Recently, Sienna reached out to hospitals for assistance in taking 6 of our ill residents. They were only willing to take one.”

What happens when a resident expires?
“Staff continue to show their heroic efforts in the work they perform. They are dedicated to the individuals they look after. The stress they are under is unimaginable. When a resident in their care sadly passes, they are the ones responsible for preparing that individual for passage to the next phase, in a dignified manner. They are heroic in their dedication to the seniors in their care, even when they must perform duties for which they had not been expected to conduct, before Covid-19.”

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